Key Themes

OVERVIEW

Introduction to partnerships

Definitions

Objectives

Types

Policy

Introduction to partnerships

This module focuses on partnership working, the different types of partnership and on key Government policies and initiatives which underpin partnership working.

Later sections identify the essential components needed to ensure partnerships work well. Finally, there is information on partnership agreements, financial planning and budget management and the accountabilities of the respective partners.

How do partnerships affect the management of money?

Intelligent partnerships can help councils get more for their money in a number of ways by:

• agreeing eligibility and shared access arrangements with others
• improving user experience by integrating care and support and extending choice
• being more effective in securing good outcomes for users via joint assessment and planning
• achieving greater efficiency from minimising duplication, improving co-ordination and sharing buildings and human resources.

Why do partnerships matter?

For the Government:

Partnership working is central to Government policies on the delivery of effective public services. It is reflected in all policy documents produced by central government departments and the Welsh Assembly. For example:

• bids for additional funding to support new policy initiatives ask for evidence that key partners have been involved in developing the application.
• the national service frameworks (for example those for older people and those with mental health needs) set shared objectives for councils and their health partners, and will also require good joint working with other stakeholders (for example, the private and voluntary sectors) if success is to be achieved.
• the recent Green Paper, Every Child Matters, is likely to herald the increasing integration of children's services and the eventual establishment of children's trusts throughout England. See the Overview section of the children's module.

Broadly, there are five main objectives which run through Government policy on partnerships, which are seen as the means of:

• Improving the user experience of services
• Ensuring easy and timely access to services
• Dealing with difficult 'wicked issues' in the delivery of services
• Promoting citizen involvement in shaping services
• Making best use of all the available resources

For councils:

Partnerships enable priorities to be developed and services delivered for the overall benefit of local communities. The use of the resources (financial, human resources, and capital assets) available to partner agencies can be maximised to achieve common objectives.

For service users:

Users of social care services often have needs which fall beyond the scope of social services alone. Failure to co-ordinate with other services undermines the benefits of the services provided. Health, education and housing are particularly critical. Because the effectiveness of social services uniquely depends on established joined-up working with others, strong partnerships need to be central to achieving good outcomes for users. This is referred to below as a state of interdependence with others.

The Joint Review Team has found that a willingness to share control and resources with other agencies is one of the key attributes of successful councils. Some councils have found this difficult and have concerns about the implications of getting too close to partners.

This module focuses on identifying the criteria which will assist councils in making the most of partnership working to improve services for users and maximise the use of their scarce resources.

"Greater maturity and self confidence needs to encourage a move towards a state of 'interdependence' with others. The benefits to be reaped are significant: extended choice, better value for money, better connections across services and the pooling of skills, resources and capacity to do the job."

Pathways to Improved Social Services in Wales 2001/2 Joint Review Team

Definitions

There is no one agreed definition of partnership.

The word partnership can be used to describe very different arrangements. For example, partnership might be used to describe a loose grouping of different agencies and local people who meet four times a year to share information or, in contrast, a partnership might be used to describe a formal arrangement between agencies where budgets for services are 'pooled' under Section 31 of the Health Act 1999.

The development of the local partnerships, will require a culture of shared ownership and common working arrangements across organisational and professional boundaries, as well as genuine co-operation between organisations of different sizes and ways of working.

It is critically important to be clear about what you are trying to achieve and what the partnership is responsible for. Everyone needs to know what is expected of them and it needs to be possible to assess how well you are doing in working towards achieving your aims and objectives. See Being a good partner for more information on this.

A useful definition:

This definition is to be found in their publication 'A Fruitful Partnership' (published in November 1998).

Objectives (Exhibit 1)

Source: Joint Reviews

Improving user experience of public services

This is the key central objective of partnership working to which all other objectives contribute.

When partnerships work well service users and carers can benefit in a number of ways:

• Systems can be streamlined making it easier to access services.
• Instead of several assessments by different agencies there can be one joint assessment.
• Services which complement each other can be developed avoiding overlap and duplication.
• Economies can be achieved making sure the money goes further.

This module is intended to make sure partnerships keep a focus on the core business of delivering good outcomes for users and carers through the delivery of 'Best Value' services. There are times when agencies become so immersed in the processes of setting up the partnership arrangements that they lose sight of this key objective of the partnership.

Dealing with the 'wicked issues'

'Wicked issues' are those challenging cross-cutting issues which need to be addressed by a number of agencies in a co-ordinated and planned way. This involves harnessing the skills of statutory agencies such as local authorities and the health service alongside the skills and resources of voluntary and private sector agencies. Managing risk for vulnerable adults and children is a good example of where agencies need to work in close partnership to share information, assess risk and support improvement by co-ordinated care. Wicked issues may be so defined because:

• They are complex - not easy to understand or simple to solve by one service.
• They are chronic - they have been around a long time and are quite deep rooted.
• They require a long-term strategy - careful planning and implementation over a number of years is necessary.
• They involve doing things differently - current responses are not working.

A partnership approach will bring added value to tackling these problems, with each agency bringing its own perspectives and approaches to the partnership to help produce a more comprehensive set of proposals to tackle the problem. Hospital discharge pressures are a good example. For further information refer to Introduction.

Citizen involvement

There is an increasing awareness within government, at both a national and local level, of the need to promote the active involvement of local people in the planning and delivery of services. This assists with developing a positive and cohesive community and helps to ensure services are designed and delivered to meet local need.

Within Social Services, effective engagement with users and carers should include consultation, involvement and empowerment.

Involving Children and Young People in Wales

Involving users of services in the planning and review of service provision is a well-established practice intended to ensure effective delivery. The central focus of planning and delivering services must be the needs of children and young people and their families, rather than the requirements of existing patterns of service provision. The local forum representing children and young people will have a central part to play in this process. School councils are to be set up on a statutory basis in Wales and Guidance is currently the subject of consultation and development under proposals contained in " The Learning Country. " www.wales.gov.uk/subieducationtraining/content/PDF/learningcountry-e.pdf

A broad range of representatives of the interests of children and young people should have the opportunity to contribute. This will include those who are from black and minority ethnic communities, travellers, gay and lesbian, homeless, looked after, offenders, carers, those excluded from school and those with disabilities.

A variety of creative approaches using a range of methods and processes will be needed and particular efforts made to capture the views of excluded children and those who might otherwise be unheard. The experience of relevant voluntary sector organisations will be valuable in ensuring the involvement of those with special needs, including, for example those with sensory impairment and other communication difficulties and children looked after.

Working with Funky Dragon [www.funkydragon.org/fe/master.asp?n1=399], the Children and Young People's Assembly for Wales, the Assembly has sent out information on the principles and practice of participation, including references to information and sources of good practice Breathing Fire into Participation [see www.wales.gov.uk/subichildren/content/dragon/index-e.htm]. Participation should be meaningful and take place from the very beginning of the planning process rather than simply asking service users to comment on proposals that have already been drawn up. Children, young people and their families who have participated in local planning processes should receive hard evidence that their views are being listened to and that their opinions are having a real effect on service development.

This requires both sensitivity and active support by the council and partner organisations and needs to be properly resourced as a service in its own right (for example, through the commissioning of advocacy schemes). The payback to the agencies, in terms of learning from people's experience of what is needed and what works, makes this a cost-effective investment. See involving stakeholders.

"In recent years there has been an increasing recognition, in both central and local government, of the importance of successful partnership working. To tackle our most challenging problems - on health, crime, transport and the local environment we need to marshal the contributions of the public, private and voluntary sectors, and of communities themselves. We will not achieve genuinely citizen-centred services unless service deliverers work well together."

Section 2.30 of the Government White Paper - 'Strong Leadership - Quality Public Services' (December 2001)

Easy and timely access to services

Service users want to access services easily and receive a quick response.

Partnership arrangements can respond more effectively in a number of ways:

• The establishment of joint teams and integrated services makes it easier to develop a holistic approach to assessing needs and delivering services.
• The creation of single access points for referrals which avoid the frustrating process of users having to be referred to different agencies and the possibility of 'buck passing', with agencies not taking responsibility by passing to others inappropriately.
• The application of a consistent approach to eligibility criteria and the allocation of resources.
• Development of common documentation and records.

Making best use of available resources

The public sector is required to provide services which meet the requirements of the Government's 'Best Value' approach. Demands for public services constantly put pressure on the available resources, particularly in the areas of health, housing and education, the agencies which are most likely to be engaged in partnership arrangements with Social Services.

A partnership approach can lead to more cost effective solutions to meeting these needs in a number of ways:

• Budgets can be 'pooled' or jointly managed so that the total resources are utilised to meet the ongoing demands irrespective of whether these relate to the specific responsibilities of one agency.
• Professional staff can be used more flexibly, and new joint posts can be created to meet the requirements of all the partner organisations.
• The shared use of information technology and other resources, such as buildings, can be maximised.
• The ability to jointly commission or provide services in partnership offers the opportunity to be more cost-efficient in the provision of services.
• Savings which arise out of any of these potential efficiency gains can be redirected into providing additional or new services in line with the priorities of the partner agencies.

Types

There are many different types of partnership. This section considers the characteristics of the different approaches to help determine which approach is most relevant for the circumstances you might face.

You will need to consider the following:

• Relevant Government policy and guidance
• Whether a loose (informal) or tight (formal) arrangement best meets your circumstances.
• Whether your partnership will take executive decisions or be advisory only, at least in the short term.

Different types of partnership working

Paddy Cooney, of the National Institute for Mental Health in England, has developed a useful continuum for describing different ways of working together (Exhibit 3). Starting at the bottom of the pyramid, single agencies work on their own. The model then moves through a number of stages from loose networking arrangements to the tighter and more formal arrangements that will be needed for joint commissioning and/or integrated services.

This model can be used to analyse where you are at the moment and as a framework for future planning.

Source: Paddy Cooney

The model was taken from a Power-Point presentation 'Learning to Love Partnerships', which was given at a workshop organised by the Integrated Care Network(ICN). ICN's website provides useful information on all aspects of partnership working at http://www.integratedcarenetwork.gov.uk. The full presentation - 'Learning to Love Partnerships' is available from here.

Government policy and guidance

Government policy or guidance often either advises or prescribes the type of partnership and its responsibilities.

In some cases, expectations are very clear, while in others there may be some room for discretion. Types of partnerships highlights some key policies on partnerships and provides some useful links to other websites which will provide more detail.

It is important to decide at the outset the type of partnership required, the implications of adopting the chosen approach and the longer term intentions.

If you are unsure, the following issues should be considered.

There are no right or wrong answers but a discussion around these areas will help to clarify whether a 'loose'(informal) arrangement or a 'tight' (formal) arrangement is best (Exhibit 4).

One approach to determining the type of partnership would be to undertake a 'SWOT' exercise (examining the relative strengths, weaknesses, opportunities and threats) of your current position, or by simply listing the pros and cons of each option.

For example, you might start off with some terms of reference which outline the broad responsibilities of the partnership. At a later date you might move to having a more detailed partnership agreement, see Partnership agreements. As an example, you may want to refer to the Children's and Young Person's Strategic Partnership in South Tyneside which started off in this way and is now making arrangements more formal through a Children's Trust.

A more formal ‘'tight’' arrangement from the outset might be suitable where there is clarity about the particular issues that need addressing, and there is agreement that the best way of dealing with these is by developing integrated services or pooling budgets. This works best if partners already have a trusting relationship and track record of working together, both at strategic and operational levels.

Linked to the decision about the type of partnership arrangement to be put in place is the need to determine whether the partnership will be advisory or will be able to take executive decisions.

In the former, the partnership will make recommendations to the partner organisations for the formal decisions to be made. For example, many joint planning groups such as National Service Framework (NSF) implementation groups make recommendations which are then referred to the partner organisations for a final decision. For example the recommendation maybe passed to the Cabinet of the local authority and the Board of the primary care trust).

In the latter, executive decision-making responsibilities and accountability are delegated to the Board or Committee of the partnership by the parent bodies within the terms of the formal agreement reached by those parent bodies. Examples are some Joint Commissioning Boards or Joint Committees for Mental Health. The agreement may require that council members are part of the boards or committees which oversee the work of the partnership.

If it is decided to pool budgets or develop integrated commissioning or service delivery through the development of 'Trusts' then it will be necessary to develop new arrangements for decision making. See Governance Issues for more information on this.

As with the decision to adopt either a 'loose' or 'tight' arrangement, there is the option of starting with an advisory partnership and, over time, moving to the creation of an executive partnership. Ideally the arrangements for executive decision making should closely reflect the type of partnership established. A formal partnership would be less effective if it had to submit all of its proposals to the parent bodies for executive decisions.

If you would like more information, the CIPFA publication 'Partnerships and Partnering' provides more detail. You can access the CIPFA website at www.cipfa.org.uk.

Policy

This section highlights a number of policy developments on partnerships and lists some partnerships which should be in place in your Authority.

Local Strategic Partnerships

A local strategic partnership (LSP) is an multi-agency body, which matches local authority boundaries, and aims to bring together, at a local level, the different parts of the public, private, community and voluntary sectors. To see the relevant government guidanxe, click here.

Local strategic partnerships are key to addressing the multi-faceted and complex problems facing communities. They are expected to work together to identify the priorities and targets for their areas, and to ensure that resources are directed to tackling these. The Neighbourhood Renewal Unit has produced a range of useful information, including a model performance management framework for LSP's.
Further details can be found here.

Children and Young People's Partnerships

The guidance and Co-ordinated Service Planning for Vulnerable Children and Young People in England covers the establishment of Children and Young People's Partnerships and the purpose of Children's Services Plans.

A full copy of the guidance can be found here. The main points on developing Children and Young People's Partnerships include:

• Partnerships will be a subset of the local strategic partnership (LSP)
• Partnerships will jointly address levels of need, set shared objectives and agree targets for outcomes for vulnerable children and young people. These will be included in a Children's Services Plan.
• Partnerships will be involved in monitoring progress in implementing action noted in Children's Services Plans.
• Children, young people and their families and the voluntary and community sectors should be involved with the partnership.

In Wales, authorities are asked to develop Children and Young People's Framework Partnerships that represent local authorities, health services, and the voluntary sector. These partnerships have responsibility for agreeing a five-year strategy for services to children and young people aged 0 to 25.
The Children and Young People's Framework will act as the key strategic statement of how the wellbeing of all children and young people in the area will be improved over a five-year period. Its purpose will be to:

• provide a strategic vision to which the work of all local bodies affecting children and young people will contribute;
  
• give a clear description of how national strategies, policies and priorities will be tackled locally;
  
• establish jointly determined strategic objectives for services to promote the wellbeing of children and young people;
  
• give a new perspective on corporate and service priorities across the whole range of sectors by considering their impact on children and young people and ensuring that they are consistent and mutually supportive.

In recognition of the wide age range and the differing needs of children and young people, authorities are asked to set up sub-groups to implement the Framework strategic priorities. Children's Partnerships focus on children aged 0 to 10 and Young People's Partnerships on young people aged 11-25. In some cases Children's Partnerships have been built onto Early Years Development and Childcare Partnerships; in others the EYDCP has remained as a sub-group of the Children's Partnership. Guidance for these partnerships is set out in the Welsh Assembly publication 'Children and Young People - A Framework for Partnership'.

Children and Young People's Framework Partnerships have now been formed in all 22 local authority areas of Wales, The results of the Framework Partnerships' planning for children and young people are then incorporated in local health, wellbeing and social care strategies. This relationship is set out in HSC&WB Strategy Guidance.
Further information is available at http://www.wales.gov.uk/subichildren/content/partnership/index.htm
http://www.wales.gov.uk/subihealth/content/keypubs/pdf/policy-guide-e.pdf

Removal of legal hurdles that hamper joint working

The Health Act(1999) removed legal and financial constraints, thereby enabling the NHS and local authorities in England and Wales to provide and commission more integrated services. Three approaches to developing closer partnership working were encouraged by the change of legislation:

• Pooled budgets - health and local authorities were freed to pool their resources to develop services.
• Lead commissioning - either the local authority or primary care trust could take the lead in commissioning a range of services.
• Integrated provision - a single agency could provide both health and social care services.

Guidance on the Section 31 Partnership Arrangements and a checklist for using Health Act flexibilities can be found here.

Information on developing the use of Health Act flexibilities in Wales can be found here.

An example of a Section 31 Agreement using Health Act Flexibilities can be found here.

Sandwell Metropolitan Council has explored Care Trust status for Mental Health Services, Section 31 flexibilities for services with learning disabilities and joint arrangements between the council and three Primary Care Trusts for older people's services. The SSI Annual Performance letter for 2001/2 said:

'Excellent partnerships with health have ensured continued innovation and progress on delivering quality services to Sandwell service users, particularly in relation to Adults and Older People.'

Barnsley Metropolitan Council was on special measures until March 2001 and achieved a two star performance rating in May 2002. The council has developed excellent partnership arrangements with Health and made use of Health Act flexibilities for all adult groups. Barnsley's Annual performance letter said:

'The close working partnership with the Health Authority and Trusts has resulted in considerable improvements on the interface indicators with an 18% reduction on the emergency admissions of older people and 41% fewer emergency psychiatric re-admissions. The number of delayed transfers of care remain some of the lowest in the Region. Despite limited financial resources the department achieved the national target for efficiency mostly due to the use of Health Act flexibilities.'

The 11th Annual Report of the Chief Inspector of Social Services 2001 - 2002

Care Trusts

The Health and Social Care Act 2001 refers to the development of Care Trusts. Care Trusts are set up to deliver integrated health and social care services in a single NHS organisation. They can both commission and deliver services.

Eight care Trusts have so far been developed in England.

Information on Care Trusts pilots can be found here.

An example of a Care Trust application can be found here.

Children's Trusts

Children's Trusts aim to better integrate and co-ordinate services for children. A Trust might involve some or all of the Children's services provided by local authorities, Social Services and Health. A Trust might be designed to focus on commissioning or providing services, or a combination of the two. A Children's Trust will be accountable to the local authority and health bodies that delegate functions to it. Children's Trusts are being piloted in England only. 35 sites have been selected as Children's Trust pathfinders.

Details can be found here.

Health, Social Care and Well-being Strategies in Wales

In Wales, local authorities and local health boards are required to work together with a range of other partners to develop Health, Social care and Well-being Strategies by 1 April 2005. Draft strategies should be in place by 31st March 2004.

Detailed guidance can be found here here.

The Government initiative: 'Building Capacity and Partnerships in Care’

Building Capacity and Partnerships in Care' provides a framework for future working relationships between independent sector providers and those who have responsibility for commissioning services. Action checklists are provided on:

• Information for good commissioning
• Strategic planning
• Building capacity, confidence and reducing instability
• Joint working

Further information can be found here.

Thurrock 'unitary' Council has developed a mature and positive relationship with its service providers.

"While the small number of service providers helps communication, there is also a willingness to engage and share problems...There are strategic and operational meetings in which providers share ideas and information about services and the future".

Joint Review Report Thurrock July 2002

Local compacts with the voluntary sector

In November 1998 the Government established a Compact on Relations between Government and the Voluntary and Community Sector in England. A similar compact has been established in Wales. This sets out agreed principles for effective working relationships. Local authorities have been encouraged to adopt these principles and to establish local compacts. More information can be found here. Specific information on developing local compacts in Wales can be found here.

Between February and November 1999 the Social Services Inspectorate in England examined the working relationship between local councils with social services responsibilities and the voluntary sector in seven councils. Some information on their findings can be found here. The detailed inspection report is available here.

Other key partnerships

As well as the initiatives listed above there are other partnerships which will exist in your Authority. These are noted in the table below which includes links to the appropriate website.